Larger femoral heads may reduce risk of revision THA vs. smaller heads
Key takeaways:
- Larger 32-mm and 36-mm femoral heads reduced risk of all-cause revision THA compared with smaller 28-mm heads.
- Concerns of loosening, polyethylene wear and corrosion may not be warranted for larger heads.
According to published results, the use of larger 32-mm and 36-mm femoral heads was associated with significantly reduced risk of all-cause revision total hip arthroplasty compared with use of smaller 28-mm heads.
Researchers performed a retrospective, single-center study of data from 10,104 primary THA procedures (mean patient age of 69 years) from 2003 to 2019 with mean follow-up of 6 years. According to the study, 3,295 THAs (32.6%) were performed with 28-mm heads; 4,858 THAs (48.1%) were performed with 32-mm heads; and 1,951 THAs (19.3%) were performed with 36-mm heads. Outcome measures included all-cause revision, revision for dislocation and all-cause revision excluding dislocation.
The overall all-cause revision rate was 1.7% for all head sizes. Researchers found all-cause revision rates decreased as head sizes increased. All-cause revision rates were 2.7% for THAs with 28-mm heads, 1.3% for THAs with 32-mm heads and 1.1% for THAs with 36-mm heads. Similarly, implant survivorship at 17 years was 95.6% for THAs with 28-mm heads, 95.8% for THAs with 32-mm heads and 97.9% for THAs with 36-mm heads.
Researchers noted the 32-mm and 36-mm head sizes were associated with a significantly reduced risk of revision for all causes, with a particularly reduced risk of revision for dislocation. They noted all-cause revision excluding dislocation showed no significant differences between head sizes.
While concerns of early revision for aseptic loosening, polyethylene wear and taper corrosion are commonly considered when using larger femoral heads, researchers concluded these concerns were unfounded in this specific cohort.
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